Session 28, February 12, 2019

Bringing Digital to Life

Neil Gomes Chief Digital Officer and Executive Vice President

Maia Ottenstein Digital Experience Design Lead for UX Research

The DICE Group at Thomas Jefferson University and Jefferson Health

CONFLICT OF INTEREST

Neil Gomes, MBA, M.Ed., CSM, CSPO

Executive Vice President and Chief Digital Officer

Has no real or apparent conflicts of interest to report.

Maia Ottenstein

Digital Experience Design Lead for UX Research

Has no real or apparent conflicts of interest to report.

• Understanding the patient journey

• How to identify pain points

• Identifying and addressing opportunities for innovation

• How Jefferson Health addresses problems in healthcare through

The DICE Group

• Three examples of how we are transforming the

patient journey

• The impact of design solutions on the overall

healthcare journey

AGENDA

• Identify the current state of a healthcare consumer journey and how digital

platforms and solutions can enhance these journeys and make them more

meaningful.

• Illustrate opportunities for innovative change within which health systems can

provide better care.

• Share how innovative solutions have transformed our consumer journey.

• Demonstrate the advantages of gaining consumer trust and support from a

business perspective.

LEARNING OBJECTIVES

EXISTING APPROACHES

TO IMPACTING

THE PATIENT JOURNEY

WHAT MOST PEOPLE THINK OF WHEN THEY

HEAR “PATIENT JOURNEY”

GO HOMEMEET WITH DOCTORMAKE APPOINTMENT

EXPERIENCE SYMPTOMS

ACTION

Recognize something is

wrong.

Decide the symptoms are

worthy of a doctor’s visit,

call a primary care

provider’s office.

Meet with the doctor.

Review symptoms,

feedback, and

recommendations with

doctor.

Go home, follow doctor’s

recommendations, and

feel better.

EXPECTATIONS

EXISTING SOLUTIONS

(AND WHY THEY AREN’T ENOUGH)

GO HOMEMEET WITH DOCTORMAKE APPOINTMENT

EXPERIENCE SYMPTOMS

Recognize something is

wrong.

Decide the symptoms are

worthy of a doctor’s visit,

call a primary care

provider’s office.

Meet with the doctor.

Review symptoms,

feedback, and

recommendations with

doctor.

Go home, follow doctor’s

recommendations, and

feel better.

OUR APPROACH

TO IMPROVING

THE PATIENT JOURNEY

An Identity Crisis?

Healthcare &

Education

Design

Tech

…Not Really…

More of an Existential Crisis

IDENTIFY NEEDS & OPPORTUNITIES

DIGITAL

SOLUTIONS

JEFFERSON

CONSUMER

HOSPITALS

6.1B

REVENUE

OUTPATIENT &

URGENT CARES

$218M

IN CHARITABLE

CARE

COLLEGES

6000

NURSES

PHYSICIANS

100K

ADMISSIONS

3600

FACULTY

Closed-loop Digital

Experiences

EXPERIENCE

Services via Web, Mobile,

Wearables, IoT, etc.

CONVENIENCE

Ease of Access to

Jefferson Services

ACCESS

CARE, LEARNING, WORK, RESEARCH, GIVING…

C O N S U M E R = P A T I E N T S , S T U D E N T S , S T A F F , D O N O R S … H U M A N S

…LIKE EVERYTHING ELSE DIGITAL

myBaby

@Jeff

myJeffHealth Strength

Thought Insight

Leadership

Rounding

Dashboards

JeffBNB JeffDocs

JTOG

150

TEAM

130

PROJECTS

RETURNS

THE DICE GROUP AT JEFFERSON

THE NEED FOR

THOUGHTFUL AND THOROUGH

SERVICE DESIGN

UPGRADE YOUR PATIENTS’ EXPERIENCE

Caring about your patients makes the difference between their

potential anguish and their potential delight.

GROWING DEMAND FOR SERVICE DESIGN IN

HEALTHCARE

32.51%

Consumers said in 2016 that patient ratings

are the most important information when

choosing a hospital.

80%

Of patients reported they would switch providers

for convenience factors alone.

1. https://nrchealth.com/2016-us-health-care-statistics-data-state-demographics/

2. https://nrchealth.com/wp-content/uploads/2018/12/2019-Healthcare-Consumer-Trends-Report.pdf

“Organizations need to adjust away from

an episodic model, and toward

continuous relationship cultivation.

”

“While patients praise their doctors and

nurses, they’re far less likely to rave

about their broader service

experiences.

”

- NRC 2019 Healthcare Consumer Trends

Report

WAIT FOR APPOITNTMENT, SELF

MANAGE SYMPTOMS

SCHEDULE

APPOINTMENT

COMMON PATIENT JOURNEY

FIND DOCTOR

SELF MANAGE

SYMPTOMS

EXPERIENCE

SYMPTOMS

“I was concerned but I

thought it might go away

on its own.”

“When I realized something

was really wrong I did some

research on the internet to

see what it might be. It

seemed like I could handle it

myself…”

”My doctor recommended

the specialist so I just

called them. I didn’t think

twice about it.”

“It was just kind of a ‘grin

and bear it’ situation. I

wasn’t upset. I figured I

could wait.”

ACTION

Notice something is

wrong or experience

health issue.

Try to handle the situation

without seeking medical

advice. Check symptoms

and care

Many patients interviewed

start by going to a PCP

with which they have an

established relationship.

Most patients chose to call

to schedule appointments.

Some patients noted that

they prefer they ability to

schedule online.

Most patients waited for 2

weeks to 2 months for their

appointment. None were given

instructions for how to manage

symptoms in the meantime.

Symptoms will go away

without medical advice

or intervention.

Symptoms will be

treatable at home without

medical advice.

All patients interviewed

followed

recommendations for

specialists from

another physician.

Understand availability

may be limited but

hope for an

appointment in the

near future.

EXPECTATIONS

Time between the call and the

actual appointment will be

difficult and painful.

“I was taking care of it. I was

definitely concerned, but it seemed

like there was nothing else I could

do.”

THOUGHTS/

FEELINGS

WHAT HAPPENED?

CHECK OUT

DISCHARGE

INSTRUCTIONS

APPOINTMENT

CHECK IN

AND WAIT

GO TO APPOINTMENT

THOUGHTS/

FEELINGS

“I went to one part of the office,

saw a sign that seemed to

indicate I needed to go to the

other side, and then was told to

return to the first location.”

“...it was overwhelming. I had

never been to a doctor like this

before so I [hoped] the set up

was normal for a place like this.”

“They took me back quickly but

then I waited for40 minutes.”

“I love my doctor, I’ve been seeing

her for years. We have a great

relationship.”

“We asked the same questions

every time... I guess they weren’t

being clear.”

“I was overwhelmed. I felt like

they wanted me to make really

big decisions really quickly”

C O N TINU E D

WHAT HAPPENED?

Patients reported little

trouble finding the doctor’s

office. Observations show a

great deal of confusion,

especially for initial visits.

Patient checks in with

desk staff, fills out

necessary paperwork,

and waits to be called

back.

Brought to an exam room.

Vitals taken, questions asked.

Patient waits alone for

doctor. Doctor comes in and

examines patient.

Patients experienced

trouble communicating

well with their physicians

and getting feedback in a

meaningful way.

Patient goes to check out

counter to pay for the

appointment. Sometimes

they also receive

prescriptions at this time.

EXPECTATIONS

Doctor’s office locations

will be easy to navigate

to and from.

Easy check in and

relatively short wait.

See the doctor quickly, in

and out.

Doctor gives details

about patient’s next

steps and what to expect

from their medical

condition.

Pay for appointment at

reasonable cost and

schedule follow up.

“I’m relieved I have

insurance.”

“I don’t understand how

such a short visit can cost so

much money.”

COMMON PATIENT JOURNEY

ACTION

SYMPTOM

RELIEF

ACTION

FOLLOW UP

CARE

COMMUNICATION

WITH DOCTOR

FOLLOW UP CARE

PRESCRIPTION

PICK UP

Pharmacy did not have

medication and patient

had to wait or make a

second trip.

Symptoms persisted. Unsure of

if they were doing things

correctly. Did not have a good

understanding of what would

happen.

Doctor was impossible to

get hold of.

For some, symptoms

persisted and the patient

was confused and scared.

For others, symptoms

began to improve.

”I didn’t have any problems.”

“Sometimes I have to wait but

my pharmacy is pretty

reliable.”

“I didn’t feel better. I wondered

if I was doing something wrong.

Maybe I missed something they

said. It made me nervous.”

“Even contact through

MyChart was not helpful. I

had to send multiple

messages over the course of

weeks to get a response.”

“It was frustrating. It felt like I

was stuck and I might never

feel better.”

“Once I started feeling better I

had hope that this would be

over soon.”

Go to pharmacy and get

medication.

Care will be manageable. Doctor would be

responsive, if not over

the phone at least

through email.

Relief from symptoms. Symptoms are gone and

patient moves on.

”It’s incredible. I forgot what it

was like to not be in pain.”

C O N TINU E D

COMMON PATIENT JOURNEY

THOUGHTS/

FEELINGS

WHAT HAPPENED?

EXPECTATIONS

Symptoms were relieved, acted

upon, or temporarily improved.

Patients whose symptoms

persisted were very uneasy.

HOW TO IDENTIFY PAIN POINTS

FOCUS ON THE EMOTIONAL JOURNEY

IDENTIFYING OPPORTUNITIES

Understand your patients’

ideal health care

experiences.

What do they need that

they may not even know

they can ask for?

ACTION

CHECK IN

AND WAIT

GO TO

APPOINTMENT

THOUGHTS/

FEELINGS

“I went to one part of the office,

saw a sign that seemed to

indicate I needed to go to the

other side, and then was told to

return to the first location.”

“...it was overwhelming. I had

never been to a doctor like this

before so I [hoped] the set up

was normal for a place like this.”

WHAT HAPPENED?

Patients reported little

trouble finding the doctor’s

office. Observations show a

great deal of confusion,

especially for initial visits.

Patient checks in with

desk staff, fills out

necessary paperwork,

and waits to be called

back.

EXPECTATIONS

Doctor’s office locations

will be easy to navigate

to and from.

Easy check in and

relatively short wait.

“there is a big technological gap between how

patients interact with their doctor's offices, and how

they manage the rest of their lives…”

HOW A DESIGN MINDSET CAN CHANGE THE PATIENT

JOURNEY

6. https://www.cnbc.com/2016/04/05/most-stressful-part-of-doctors-visit-the-wait-says-survey.htm

10. https://www.cdc.gov/pcd/issues/2018/18_0128.htm l

“Health care systems require continuous innovation… However…

stakeholders are not always considered when new interventions or system

processes are designed, which results in products that remain unused

because they do not account for human context, need, or fallibility…” –

CDC, Preventing Chronic Disease, 27 September 2018

CASE STUDY 1:

SHUTTLE TRACKER

CASE STUDY 1: SHUTTLE TRACKER

Jefferson Health’s Center City campus in

Philadelphia is comprised of 12 buildings

spread across 5 square city blocks

(0.3 square miles).

Adults unable to walk

0.25 miles

16.1%

Adults who have difficulty with any

physical functioning

3,700,000

Jefferson Health

outpatients in 2018.

GO TO APPOINTMENT

Patients reported little trouble

finding the doctor’s office.

Observations show a great deal

of confusion, especially for

initial visits.

“I went to one part of the office,

saw a sign that seemed to

indicate I needed to go to the

other side, and then was told to

return to the first location.”

3. https://www.cdc.gov/nchs/fastats/disability.htm

4. https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html

CASE STUDY 1: SHUTTLE TRACKER PROBLEM

Many patients and patrons of

Jefferson Health

were not aware of the

campus shuttle.

Because there is no set

schedule, patients and visitors

using the shuttle were forced

to wait

outside without any idea

of when the shuttle

would arrive next.

Drivers expect riders to know

when to be outside, and to be

there waiting. They will not

stop if they do not see

someone waiting for the

shuttle.

CASE STUDY 1: SHUTTLE TRACKER SOLUTION

Mobile view Desktop view

CASE STUDY 1: SHUTTLE TRACKER IMPACT

66.67%

Based on our most recent data, ridership

has increased by at least

The success and popularity of our Center City project has created demand for

shuttle trackers for all other Jefferson campus shuttles.

“We don’t have a tracker for this route. If I had

known when the bus would come, I would have

stayed on the clock for 10 more minutes.”

-Rider, Methodist Route

”

“Once I put the signs out, riders know that the

bus is running, and that I’ll be there soon.”

- Clyde, Morning Driver for Center City Route

”

CASE STUDY 1: SHUTTLE TRACKER IMPACT

“I use the tracker every day so that

I don’t have to wait outside.”

-Rider, Center City Loop

GO TO APPOINTMENT

Patients feel supported by their

healthcare system and appreciate the

extra mile to make going to the doctors

office that much more accessible of a

journey.

GO TO APPOINTMENT

Patients reported little trouble

finding the doctor’s office.

Observations show a great deal

of confusion, especially for

initial visits.

“I went to one part of the

office, saw a sign that seemed

to indicate I needed to go to

the other side, and then was

told to return to the first

location.”

CASE STUDY 2:

KNOCK, SIT, ASK

CASE STUDY 2: KNOCK, SIT, ASK PROBLEM

“physicians don’t have the support they need to sustain good patient

communication skills…”

“a positive doctor-patient relationship can have statistically significant effects on

‘hard health outcomes’…”

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/

9. https://health.usnews.com/health-news/patient-advice/articles/2015/04/20/why-nice-doctors-are-better-doctors

“Doctors tend to overestimate their abilities in communication…

75% of the orthopedic surgeons surveyed believed that they

communicated satisfactorily… but only 21% of the patients reported

satisfactory communication with their doctors.”

CASE STUDY 2: KNOCK, SIT, ASK PROBLEM

APPOINTMENT

“They took me back quickly

but then I waited for40

minutes.”

“I love my doctor, I’ve been

seeing her for years. We

have a great relationship.”

Brought to an exam room.

Vitals taken, questions

asked. Patient waits alone

for doctor. Doctor comes in

and examines patient.

"It's really frustrating here... I

don't understand why they

are keeping me here. I could

be just sitting here at home.

I'm confused and

overwhelmed. I don't know

what's going on! All these

tests…"

-Patient in ACE unit at

Methodist Hospital

DISCHARGE

INSTRUCTIONS

“We asked the same

questions every time... I guess

they weren’t being clear.”

“I was overwhelmed. I felt like

they wanted me to make

really big decisions really

quickly”

Patients experienced

trouble communicating well

with their physicians and

getting feedback in a

meaningful way.

CASE STUDY 2: KNOCK, SIT, ASK SOLUTION

What Medical Questio

s Can

To You and Your Loved Ones,

We Answer?

What Medical Questio

s Can

To You and Your Loved Ones,

We Answer?

CASE STUDY 2: KNOCK, SIT, ASK IMPACT

Press Ganey scores in the ACE Unit at Methodist Hospital have

increased since implementation…

Communication with Doctors

Discharge Information

Physician Scores

CASE STUDY 2: KNOCK, SIT, ASK IMPACT

APPOINTMENT

“They took me back quickly

but then I waited for 40

minutes.”

“I love my doctor, I’ve been

seeing her for years. We

have a great relationship.”

Brought to an exam room.

Vitals taken, questions

asked. Patient waits alone

for doctor. Doctor comes in

and examines patient.

DISCHARGE

INSTRUCTIONS

“We asked the same

questions every time... I guess

they weren’t being clear.”

“I was overwhelmed. I felt like

they wanted me to make

really big decisions really

quickly”

Patients experienced

trouble communicating well

with their physicians and

getting feedback in a

meaningful way.

CASE STUDY 2: KNOCK, SIT, ASK IMPACT

APPOINTMENT

“My wife has been in and out of

the hospital for years...We

would do something like this.

We did forget a lot of our

questions. And I always missed

the doc [checking in].”

-Patient in ACE Unit at

Methodist Hospital

Patient is able to have a

meaningful conversation

with the doctor in which

every question they have is

addressed and answered

clearly.

DISCHARGE

INSTRUCTIONS

“My daughter handles all my

healthcare issues…. This looks

like something she would

use… she would like to see

it.”

-Patient in ACE Unit at

Methodist Hospital

Patients understand how to

continue treatment and

what to expect moving

forward.

CASE STUDY 3:

SKCC KIOSKS

FOLLOW UP CARE

Symptoms persisted.

Unsure of if they were

doing things correctly.

Did not have a good

understanding of what

would happen.

“I didn’t feel better. I

wondered if I was doing

something wrong.

Maybe I missed

something they said. It

made me nervous.”

CASE STUDY 3: SKCC KIOSKS PROBLEM

CHECK IN AND WAIT

“...it was overwhelming. I

had never been to a doctor

like this before so I [hoped]

the set up was normal for a

place like this.”

Patient checks in with desk

staff, fills out necessary

paperwork, and waits to be

called back.

63%

“Patients said that the most

stressful thing about going to

their MD was waiting.

6”

6. https://www.cnbc.com/2016/04/05/most-stressful-part-of-doctors-visit-the-wait-says-survey.html

Questions - “What can I bring?”, “Is

this working?”

Emotions – Depression, Guilt,

Weakness, Isolation

Questions - …

Emotions – Relief, Lost, Paranoia,

Worry

Questions – “What symptoms

should I look for now?”, “Will it

come back?”

Emotions – Triumph, Relief, Worry,

Paranoia

Remission

Treatment

Recurrence

CASE STUDY 3: SKCC KIOSKS SOLUTION

Kiosk home screen Event detail screen Event registration confirmation

Before Oct. 2018

Patient awareness of opportunities for

learning, support, and other events were

minimal.

Oct. 1, 2018 – Jan. 2, 2019

237 interactions with our kiosks.

Event registrations increased by 16.69%

“People really like the convenience of it.

They can register for more than one event

at a time…”

-Employee at the SKCC Welcome Center

CASE STUDY 3: SKCC KIOSKS IMPACT

FOLLOW UP CARE

Symptoms persisted.

Unsure of if they were

doing things correctly.

Did not have a good

understanding of what

would happen.

“I didn’t feel better. I

wondered if I was doing

something wrong. Maybe

I missed something they

said. It made me

nervous.”

CASE STUDY 3: SKCC KIOSKS IMPACT

CHECK IN AND WAIT

“...it was overwhelming. I

had never been to a

doctor like this before so I

[hoped] the set up was

normal for a place like

this.”

Patient checks in with

desk staff, fills out

necessary paperwork, and

waits to be called back.

Realistic expectations for

long term care. Continuous

support and education from

healthcare institution

throughout treatment

journey.

“[The events that SKCC

offers] improve patients’

recovery and emotional

wellbeing.”

-Researcher for Palliative

Care at Jefferson Health

FOLLOW UP CARE

CASE STUDY 3: SKCC KIOSKS IMPACT

CHECK IN AND WAIT

“We encourage people to

come here and they’re

always glad when they

do.”

-Employee at SKCC

Welcome Center

Check in and peruse

Kiosks. Learn about events

and support from SKCC

while waiting for

appointment.

IMPACT OF DESIGN IN HEALTHCARE

IMPACT OF DICE AT

JEFFERSON HEALTH

1.46M

Raised via online

donation app

7.5M

Saved by staff online

training

10K

Physician hours saved

by online training

10K

App downloads

Yearly saving for

staffing costs in ER

Rating increase in

18 months by

rounding app

CMS

ORIGINAL PATIENT JOURNEY

UPDATED PATIENT JOURNEY

Research by AHRQ has proven that increasing patient and family engagement

has a multitude of benefits including:

– Improve quality and safety

• “patients and families… become allies… through ‘informed choices, safe medication use,

infection control initiatives, observing care processes, reporting complications, and

practicing self-management.’”

– Improve CAHPS scores

– Improve patient outcomes

• “emotional health, symptom resolution, functioning, pain control, and physiologic

measures such as blood pressure and blood sugar levels.

”5

– Increase employee satisfaction and retention

– Reduce errors

– Improve financial performance

• “patient and family engagement ‘consistently predicts hospital performance on an array

of crucial business outcomes’”

SERVICE DESIGN FOR HEALTHCARE

BUSINESS CASE

5.https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_PFE_Benefits_Hosp_508.pd

Our consumers,

vendors, donors, and

community are our

partners; we develop

synergistic

relationships and grow

together

Great Partners

Innovation must not be

the currency of a few,

but the combined

wealth of many and

platforms can make

this a reality

Great Platforms

From design to

development to support,

inspired, motivated, and

agile teams move us

into the future

Great Teams

TRANSFORMATION

T H E E Q U A T I O N F O R

T RAN S FO R M AT I O N

Great things in business are never done by one

person. They're done by a team of people.

S T E V E J O B S

50
Resources
https://nrchealth.com/2016-us-health-care-statistics-data-state-demographics/
https://nrchealth.com/wp-content/uploads/2018/12/2019-Healthcare-Consumer-Trends-Report.pdf
https://www.cdc.gov/nchs/fastats/disability.htm
https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html
https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtoget
started/How_PFE_Benefits_Hosp_508.pdf
https://www.cnbc.com/2016/04/05/most-stressful-part-of-doctors-visit-the-wait-says-survey.html
https://www.ncbi.nlm.nih.gov/pubmed/8953956
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/
https://health.usnews.com/health-news/patient-advice/articles/2015/04/20/why-nice-doctors-are-better-
doctors
https://www.cdc.gov/pcd/issues/2018/18_0128.htm l

Neil Gomes, MBA, M.Ed., CSM, CSPO

Executive Vice President and Chief Digital Officer

Linkedin.com/in/neilgomes

Twitter: @neilgomes

Maia Ottenstein

Digital Experience Design Lead for UX Research

Linkedin.com/in/maiao

Email: maia.ottenstein@Jefferson.edu

THANK YOU!